Association between the COVID-19 pandemic and psychiatric symptoms in people with pre-existing obsessive-compulsive, eating, anxiety, and mood disorders: a systematic review and meta-analysis of before-after studies.

Abstract

To determine whether, in people with pre-existing obsessive-compulsive, eating, anxiety, and mood disorders, the COVID-19 pandemic was associated with a change in psychiatric symptoms, compared to pre-pandemic levels. We searched MEDLINE, CINAHL, PsychINFO, and EMBASE from inception until February 16th, 2022. Studies were included if they reported pre-pandemic and during-pandemic psychiatric symptoms, using validated scales, in people with pre-existing mood, anxiety, eating, or obsessive-compulsive disorders. Two reviewers independently screened studies, extracted data, and assessed evidence certainty. Random-effects meta-analyses were conducted. Effect sizes were reported as standardized mean differences (SMD) with 95% confidence intervals (CIs). Eighteen studies, from 10 countries, were included. Of the 4465 included participants, 68% were female and the average age was 43. Mood and obsessive-compulsive disorders were the most studied disorders. During-pandemic psychiatric measurements were usually collected during nationwide lockdown. Obsessive-compulsive symptoms worsened among people with obsessive-compulsive and related disorders, with a moderate effect size (N = 474 [6 studies], SMD = -0.45, 95%CI -0.82, -0.08, I2 = 83%; very low certainty). We found a small association between the COVID-19 pandemic and reduced anxiety symptoms in people with mood, anxiety, obsessive-compulsive, and eating disorders (N = 3738 [6 studies], SMD = 0.11, 95%CI 0.02, 0.19, I2 = 63%; very low certainty). No change in loneliness, depressive or eating symptoms was found. People with obsessive-compulsive and related disorders may benefit from additional monitoring during the COVID-19 pandemic and possibly future pandemics. Other psychiatric symptoms were stable in people with the specific disorders studied. Overall, evidence certainty was very low. This article is protected by copyright. All rights reserved.